Project Summary/Abstract When parents quit smoking, their life expectancy is increased by an average of over 10 years, future tobacco- related poor pregnancy outcomes are eliminated, their children have much lower odds of becoming adult smokers, and their children may no longer be exposed to high levels of tobacco smoke, decreasing the odds of contracting diseases caused by tobacco smoke exposure and resulting in fewer missed school days. Helping parents and household members quit smoking also improves the financial resources of families, decreases the risk of developmental delays, and lowers the risk of house fires. Parents who smoke are often medically underserved, visiting their child's healthcare provider more often than they see their own clinician, if they even have one. Despite this extraordinary opportunity for intervention, child healthcare settings deliver effective tobacco dependence treatment to parents less than 2% of the time. Routinely delivered tobacco control to parents in child healthcare settings would benefit the overall health of the nation. The goal of the proposed study is to ensure that every parent who smokes tobacco or is a dual user of tobacco and e-cigarettes and visits their child's doctor receives evidence-based assistance to quit. We propose testing an innovative EHR systems platform (iEHR) in pediatric practices. The iEHR will facilitate universal screening for household tobacco use and routine offering and provision, if desired, of tobacco cessation services. We will compare this intervention to iEHR + navigator to test the effectiveness of additional support by a community health navigator. The navigator will work with pediatric offices to assist household tobacco users in cessation through telephone follow-up, ensuring access to services, and home visits, based on what they want to help them quit smoking. This trial will address critical unanswered questions of effectiveness, sustainability, and cost-effectiveness of a parental tobacco cessation intervention that supports delivery of tobacco cessation services using iEHR, with or without a navigator. This proposal is in exact alignment with NCI's objective to fund research to reduce the burden of cancer for patients and other affected persons through improvements in early detection, prevention, healthcare delivery, quality of life, and/or survivorship related to cancer. Aims are: A1. To compare parents' combusted tobacco quit rates, and adoption of tobacco free behaviors between the two intervention arms (1: iEHR+Navigator vs. iEHR; 2: each intervention vs. usual care control) A2. To establish the incremental cost per quit of the two intervention arms vs. usual care control A3. To assess the delivery and sustainability of the interventions Building on the success of past trials, this application will evaluate an innovative EHR-linked tobacco cessation intervention addressing household tobacco use with and without navigator support. The study is designed to yield fully-integrated, cost-effective, disseminable, and sustainable strategies to optimize parental cessation outcomes throughout child healthcare settings nationally.